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Jowett et al reported in their elegant study on the role of diet in maintaining remission in patients with ulcerative colitis (Gut 2004;53:1479–84). Surely the effect of diet has an essential, but often forgotten, role in altering the course of disease in all types of inflammatory bowel diseases. This role does not necessarily act by maintaining patients in remission clinically, but perhaps more importantly by minimising the activities of the disease and rendering it quiescent.
We have recently reported a case of active stricturing Crohn’s disease in an adult female patient with high stoma output.1 She was treated solely with casein base formula (Modulen IBD-Nestle, Vevey, Switzerland) for three weeks. Her stoma output was reduced from 2800 ml to 400 ml per day by day 10. Serum albumin and serum protein significantly increased also. She subjectively felt better and pain free and stopped her opiate and non- opiate formula. The casein based formula is a nutritionally complete formulation containing a natural anti-inflammatory growth factor, transforming growth factor α2. The mechanism for inducing remission in our patient was possibly inhibition of expression of MHC class II protein in downregulating the inflammatory response.2
Previous studies have shown that there is a decrease in plasma antioxidant defences in all types of inflammatory bowel disease.3 This is mirrored by an increase in free radical peripheral leucocyte DNA damage. It is therefore possible that the casein based formula acts as an antioxidant to minimise the oxidative stress that occurs in patients with active Crohn’s disease. Another possible mechanism is that this formula may have a role as a prebiotic by stimulating the activity of bacteria which are already present in the gut.
Remission induced in our case study highlights the part played by a casein based formula in the management of adult Crohn’s disease. The encouraging result demonstrates the need to treat similar cases with dietary measures first. This opportunity should not be missed as it may well obviate the need for surgical intervention or administration of potent pharmacotherapeutic agents which carries the risk of several comorbidities.
Conflict of interest: None declared.